Healthcare Provider Details

I. General information

NPI: 1700862166
Provider Name (Legal Business Name): PEDRO CASTRO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 09/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 EAKER STREET
EDEN TX
76837
US

IV. Provider business mailing address

223 S ABE ST
SAN ANGELO TX
76903-6305
US

V. Phone/Fax

Practice location:
  • Phone: 325-869-5500
  • Fax: 325-869-5692
Mailing address:
  • Phone: 325-655-7969
  • Fax: 325-655-7976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberH9840
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: